Avoid Retail Clinics for Pediatric Care, AAP Says

Steven Fox

February 24, 2014

Although in-store medical clinics have been proliferating since they first appeared in 2000, most medical societies and many physicians think they are a bad idea.

Firmly in that camp is the American Academy of Pediatrics (AAP), which renewed its opposition to retail-based clinics (RBCs) in a policy statement published online February 24 in Pediatrics.

The growth of RBCs has been significant, with such clinics numbering 6000 as of 2012, according to the AAP statement. In previous surveys, about 15% of respondents anticipated that in the future they would likely be using in-store clinics for at least part of their children's medical care. (Most people treated at in-store clinics are adults.)

The policy statement updates a 2006 statement by AAP's Committee on Practice and Ambulatory Medicine and reiterates the group's view that RBCs are an inappropriate source of primary care for pediatric patients.

"The AAP continues to oppose RBCs as a source of primary care for pediatric patients, because they risk increasing care that is fragmented and detrimental to the medical home concept of longitudinal and coordinated care," the committee writes.

They express concern that as young patients grow older and their health issues become more complex, personnel at RBCs who are unfamiliar with the patient's medical history may miss important diagnoses.

The AAP also opposes payers offering lower copays or other financial incentives for patients to receive care at RBCs rather than from their pediatricians or primary care physicians. "Payment for care received within the medical home must be continually evaluated to ensure that pediatricians and other primary care physicians receive adequate compensation for the continuous, coordinated, and comprehensive health care that they provide," the academy writes.

The AAP acknowledges, however, that situations may arise in which scheduling or other considerations make a visit to an RBC a reasonable alternative to a physician visit. In such cases, the AAP notes, the RBC and the medical home need to develop a formal collaborative relationship that includes:

  • use of evidenced-based pediatric protocols and standards;

  • provisions of pediatric quality review;

  • prompt communication with the patient's medical home regarding when and why the patient visited an RBC, along with the outcome of such visits;

  • referral of patients back to their pediatric medical home and assistance in establishing a pediatric medical home for one for those who do not have one; and

  • making sure formal arrangements are in place for after-hours coverage or emergency situations that may arise when a patient visits an RBC.

The AAP acknowledges the difficulties pediatricians face in navigating the rapidly evolving healthcare landscape. "In an era of stagnant or decreasing physician payment rates by government and private payer sources, one of the primary challenges for the primary care pediatrician is to continue to adhere to the central tenets of the medical home model by providing high-quality coordinated care in appropriate settings that optimize access, outcomes, and value," they write.

The authors have disclosed no relevant financial interests.

Pediatrics. Published online February 24, 2014.

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